Provider Demographics
NPI:1487206181
Name:MCPHERSON, NICOLE DIONNE (NP)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:DIONNE
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 WELLS AVE APT 509
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-2886
Mailing Address - Country:US
Mailing Address - Phone:347-432-8821
Mailing Address - Fax:
Practice Address - Street 1:63 WELLS AVE APT 509
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-2886
Practice Address - Country:US
Practice Address - Phone:347-432-8821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0648342363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health